New Patient Information

We are accepting new patients at Hillcrest Hearing & Balance Center. Please contact one of our offices for an appointment at a location convenient for you. All patients for Hillcrest Hearing & Balance Center must have a current Southwest Ohio ENT Specialists Patient Information Form and Privacy Practices Acknowledgment form on file. Forms are updated yearly. These forms will be accepted at the check-in desk upon arrival. If you have not received your forms in the mail after scheduling your appointment, you may copy and complete the forms and bring them with you.


Patient Forms

Patient Information Form
Required for all new patients and is updated yearly

Privacy Practices
Required for all new patients and is updated yearly

Notice of Privacy Practices (HIPAA)
Privacy Practices policy for your records

Audiological Case History
Required for all new patients and is updated yearly

Special Testing Information Sheet
VNG or ENG Testing Instructions


 

Payment Options

Most health insurance plans, including Medicare, do not cover the cost of hearing aids, but some do. We will be happy to help you determine if you are eligible for benefits, and as a participating provider, we will file all appropriate claim forms as a courtesy. Please note: You are responsible for any balance not covered by your insurance plan.

Accepted Methods of Payment - Cash, Check, and the following credit cards: Visa, Master Card, Discover, American Express.

Care Credit - We participate in the several payment plans with Care Credit. Click here for credit application: www.carecredit.com

Balance Center
Your Balance
Treatment

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Blog
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©2014 Hillcrest Hearing and Balance Center
Contact us by location here, or call 937-222-0022